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Evaluating the feasibility of establishing a high dependency unit and its impact on intensive care

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Abstract:

This study was carried out in a 150-bed hospital which has a nine-bed intensive care unit (ICU) currently unsupported by a high dependency unit (HDU). We examined the feasibility of establishing a HDU by auditing ICU occupancy and potential HDU patients on wards. The aim of the analysis was to establish the size of the notional HDU and its impact on the ICU. The HDU feasibility was evaluated on a financial and patient care basis.

All admissions to the ICU were prospectively audited over a three-month period. Patients were classified as ICU or HDU patients according to specific criteria. There were 221 ICU admissions over the study period. Potential HDU patients being cared for on the ward were also recorded. Application of the criteria gave a breakdown in special care demand of 57% ICU classified, 32% HDU classified in ICU, and 11% HDU classified on the wards. HDU and ICU demand, based on the classification, was evaluated to determine the optimum HDU size. Various scenarios were outlined and two selected for full financial and patient care evaluation. Both scenarios were found to be viable, one being financially superior to the other but inferior in terms of patient care. A hybrid solution was proposed based on a refinement of both scenarios. The solution proposed the establishment of a four-bed HDU and reducing the ICU from nine to eight beds. It is proposed that the ICU be normally staffed for a complement of seven beds but that an eighth bed be retained that could be staffed with agency nurses employed to meet infrequent peak demand.

Keywords: AUDIT; HIGH DEPENDENCY UNIT; INTENSIVE CARE UNIT

Document Type: Research Article

Publication date: June 1, 2001

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